Parent/Guardian Consent/Signature Form
Catechist: Day:
expectations and requirements of the Religious Education Policy Statement. Parent/Guardian Signature: Please Print Name: Date:
Church of St. Anthony of Padua, to take photographs and to make recordings of my child (named below), and to use them in original or modified form in all media now or hereafter known, with or without name or information, solely for the promotion, public education, and/or fundraising activities of the Church of St. Anthony of Padua. I understand and agree that I am entitled to receive no compensation for the above. I release the Church of St. Anthony of Padua, its officers, directors, agents, employees, independent contractors, licensees and assignees from all claims that I now have or in the future may have, relating to the above. I further agree that the Church of St. Anthony of Padua will be the sole owner of all tangible and intangible rights in the above mentioned photographs and recordings, with full power of disposition. I am the parent or guardian of the minor named below, and I hereby consent to the foregoing on behalf of the minor and myself. Name of Child: Parent/Guardian Signature: Print Name: Address: Date: Phone:
Parent/Guardian Name: Name(s) of person(s) authorized to pick up my child from St. Anthony’s Religious Education classes: NAME RELATIONSHIP Parent/Guardian Signature: Return this form to your child’s catechist at the next scheduled class. |